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Architectural Distortion
Melissa Durand, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Architectural distortion (AD)
            • Synonyms

              • Puckering; "tent" sign
            • Definitions

              • Distorted breast parenchyma without discernible mass
              • May be associated with mass, asymmetry, Ca⁺⁺

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Contrast-Enhanced Mammography

                      • Image-Guided Biopsy

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Alshafeiy TI et al: Outcome of architectural distortion detected only at breast tomosynthesis versus 2D mammography. Radiology. 288(1):38-46, 2018
                                            2. Nakhlis F et al: Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 24(2):133-8, 2018
                                            3. Niell BL et al: Utility of breast MRI for further evaluation of equivocal findings on digital breast tomosynthesis. AJR Am J Roentgenol. 211(5):1171-8, 2018
                                            4. Patel BK et al: Initial experience of tomosynthesis-guided vacuum-assisted biopsies of tomosynthesis-detected (2D mammography and ultrasound occult) architectural distortions. AJR Am J Roentgenol. 210(6):1395-400, 2018
                                            5. Vijapura C et al: Imaging features of nonmalignant and malignant architectural distortion detected by tomosynthesis. AJR Am J Roentgenol. 211(6):1397-404, 2018
                                            6. Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-7, 2017
                                            7. Cohen MA et al: Radial scars of the breast encountered at core biopsy: Review of histologic, imaging, and management considerations. AJR Am J Roentgenol. 209(5):1168-77, 2017
                                            8. Patel BK et al: Clinical utility of contrast-enhanced spectral mammography as an adjunct for tomosynthesis-detected architectural distortion. Clin Imaging. 46:44-52, 2017
                                            9. Durand MA et al: Tomosynthesis-detected architectural distortion: Management algorithm with radiologic-pathologic correlation. Radiographics. 36(2):311-21, 2016
                                            10. Bahl M et al: Architectural distortion on mammography: Correlation with pathologic outcomes and predictors of malignancy. AJR Am J Roentgenol. 205(6):1339-45, 2015
                                            11. Freer PE et al: Preoperative tomosynthesis-guided needle localization of mammographically and sonographically occult breast lesions. Radiology. 275(2):377-83, 2015
                                            12. Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
                                            13. Ray KM et al: Suspicious findings at digital breast tomosynthesis occult to conventional digital mammography: Imaging Features and Pathology Findings. Breast J. 21(5):538-42, 2015
                                            14. Partyka L et al: Detection of mammographically occult architectural distortion on digital breast tomosynthesis screening: initial clinical experience. AJR Am J Roentgenol. 203(1):216-22, 2014
                                            15. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                            16. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                            17. Chansakul T et al: The postconservation breast: part 1, Expected imaging findings. AJR Am J Roentgenol. 198(2):321-30, 2012
                                            18. Chansakul T et al: The postconservation breast: part 2, Imaging findings of tumor recurrence and other long-term sequelae. AJR Am J Roentgenol. 198(2):331-43, 2012
                                            19. Gruber R et al: Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). Eur J Radiol. Epub ahead of print, 2012
                                            20. Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
                                            21. Shaheen R et al: Spectrum of diseases presenting as architectural distortion on mammography: multimodality radiologic imaging with pathologic correlation. Semin Ultrasound CT MR. 32(4):351-62, 2011
                                            22. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                            23. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                                            24. Günhan-Bilgen I et al: Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings. Eur J Radiol. 61(1):158-62, 2007
                                            25. Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 2005
                                            26. Pediconi F et al: Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance. Breast J. 11(1):23-8, 2005
                                            27. Baker JA et al: Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion. AJR Am J Roentgenol. 181(4):1083-8, 2003
                                            28. Brenner RJ et al: Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 179(5):1179-84, 2002
                                            29. Gajdos C et al: Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg. 235(2):246-51, 2002
                                            30. Krishnamurthy R et al: Mammographic findings after breast conservation therapy. Radiographics. 19 Spec No:S53-62; quiz S262-3, 1999
                                            31. Venta LA et al: Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions. AJR Am J Roentgenol. 173(2):309-16, 1999
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Architectural distortion (AD)
                                                      • Synonyms

                                                        • Puckering; "tent" sign
                                                      • Definitions

                                                        • Distorted breast parenchyma without discernible mass
                                                        • May be associated with mass, asymmetry, Ca⁺⁺

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Contrast-Enhanced Mammography

                                                                • Image-Guided Biopsy

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Alshafeiy TI et al: Outcome of architectural distortion detected only at breast tomosynthesis versus 2D mammography. Radiology. 288(1):38-46, 2018
                                                                                      2. Nakhlis F et al: Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 24(2):133-8, 2018
                                                                                      3. Niell BL et al: Utility of breast MRI for further evaluation of equivocal findings on digital breast tomosynthesis. AJR Am J Roentgenol. 211(5):1171-8, 2018
                                                                                      4. Patel BK et al: Initial experience of tomosynthesis-guided vacuum-assisted biopsies of tomosynthesis-detected (2D mammography and ultrasound occult) architectural distortions. AJR Am J Roentgenol. 210(6):1395-400, 2018
                                                                                      5. Vijapura C et al: Imaging features of nonmalignant and malignant architectural distortion detected by tomosynthesis. AJR Am J Roentgenol. 211(6):1397-404, 2018
                                                                                      6. Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-7, 2017
                                                                                      7. Cohen MA et al: Radial scars of the breast encountered at core biopsy: Review of histologic, imaging, and management considerations. AJR Am J Roentgenol. 209(5):1168-77, 2017
                                                                                      8. Patel BK et al: Clinical utility of contrast-enhanced spectral mammography as an adjunct for tomosynthesis-detected architectural distortion. Clin Imaging. 46:44-52, 2017
                                                                                      9. Durand MA et al: Tomosynthesis-detected architectural distortion: Management algorithm with radiologic-pathologic correlation. Radiographics. 36(2):311-21, 2016
                                                                                      10. Bahl M et al: Architectural distortion on mammography: Correlation with pathologic outcomes and predictors of malignancy. AJR Am J Roentgenol. 205(6):1339-45, 2015
                                                                                      11. Freer PE et al: Preoperative tomosynthesis-guided needle localization of mammographically and sonographically occult breast lesions. Radiology. 275(2):377-83, 2015
                                                                                      12. Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
                                                                                      13. Ray KM et al: Suspicious findings at digital breast tomosynthesis occult to conventional digital mammography: Imaging Features and Pathology Findings. Breast J. 21(5):538-42, 2015
                                                                                      14. Partyka L et al: Detection of mammographically occult architectural distortion on digital breast tomosynthesis screening: initial clinical experience. AJR Am J Roentgenol. 203(1):216-22, 2014
                                                                                      15. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                                                      16. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                                                      17. Chansakul T et al: The postconservation breast: part 1, Expected imaging findings. AJR Am J Roentgenol. 198(2):321-30, 2012
                                                                                      18. Chansakul T et al: The postconservation breast: part 2, Imaging findings of tumor recurrence and other long-term sequelae. AJR Am J Roentgenol. 198(2):331-43, 2012
                                                                                      19. Gruber R et al: Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). Eur J Radiol. Epub ahead of print, 2012
                                                                                      20. Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
                                                                                      21. Shaheen R et al: Spectrum of diseases presenting as architectural distortion on mammography: multimodality radiologic imaging with pathologic correlation. Semin Ultrasound CT MR. 32(4):351-62, 2011
                                                                                      22. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                                                                      23. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                                                                                      24. Günhan-Bilgen I et al: Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings. Eur J Radiol. 61(1):158-62, 2007
                                                                                      25. Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 2005
                                                                                      26. Pediconi F et al: Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance. Breast J. 11(1):23-8, 2005
                                                                                      27. Baker JA et al: Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion. AJR Am J Roentgenol. 181(4):1083-8, 2003
                                                                                      28. Brenner RJ et al: Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 179(5):1179-84, 2002
                                                                                      29. Gajdos C et al: Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg. 235(2):246-51, 2002
                                                                                      30. Krishnamurthy R et al: Mammographic findings after breast conservation therapy. Radiographics. 19 Spec No:S53-62; quiz S262-3, 1999
                                                                                      31. Venta LA et al: Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions. AJR Am J Roentgenol. 173(2):309-16, 1999